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Anatomy > Thorax ( 12.5% ) > Flashcards

Thorax ( 12.5% ) Flashcards

1
Q

The most superficial structure in the thoracic inlet is:

  • X
  • R subclavian a
  • L subclavian a
  • Thoracic duct.
  • SVC
A

Thoracic duct.

Enters the left brachiocephalic, which is the most anterior structure.

As per Nick, however the picture I have seen shows it is the deepest structure.

  • Note that Moores does not denote specifically which vessels cross, just ‘the vessels supplying the head, neck, and upper limbs’, so I would not worry so much about whether it is the right subclavian or brachiocephalic artery which crosses specifically, so this answer is tricky, but likely*
  • Veins -> arteries -> trachea -> oesophagus -> thoracic duct (in general)*
  • Vagus is deep, between the trachea and oesophagus*
  • SVC does not reach the thoracic inlet*
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2
Q

Within the thoracic inlet

  • The oesophagus lies against the body of C5.
  • The arch of the aorta passes from right to left.
  • On the right side the trachea is separated from the X and the apex of the lung
  • The veins entering the superior mediastinum lie behind the arteries.
  • The trachea touches the jugular notch of the manubrium.
A

The trachea touches the jugular notch of the manubrium.

  • Thoracic inlet is at the level of T1, and Oesophagus starts at C6, so cannot lie at C5
  • The arch of the aorta passes from right to left, but does not go as high as the thoracic inlet
  • On the left side the trachea is separated from the X and the apex of the lung by the left subclavian artery. It is right next to both of these structures on the right side
  • The veins entering the superior mediastinum lie behind the arteries. In front of the arteries
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3
Q

The 1st part of the subclavian a.

  • Is lateral to the scalenus anterior.
  • Runs deep to the suprapleural membrane
  • Has 4 branches.
  • Has the recurrent laryngeal n recurving under it on the left side.
  • Has the internal thoracic artery arising from its lower surface.
A

Has the internal thoracic artery arising from its lower surface. ​

Subclavian Artery:

  • Separated by anterior scalene into medial, posterior and lateral sections (runs anterior to it)
  • Passes behind the middle of the clavicle → axillary artery at the outer margin of first rib
  • Branches:
    • Medial (1st - 3 branches) – vertebral artery, internal thoracic and thyrocervical trunk (→ inferior thyroid artery)
    • Posterior (2nd)- costocervical trunk
    • Lateral (3rd) - dorsal scapular artery
      • Transverse cervical and suprascapular artery may come from 2nd or third part instead of coming from thyrocervical trunk.
  • Runs deep to the suprapleural membrane
  • Has the recurrent laryngeal n recurving under it on the right side.
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4
Q

The subclavian vein

  • Lies posterior to the subclavian a.
  • Lies in front of the prevertebral fascia
  • Receives the vertebral vein.
  • The divisions of the brachial plexus lie posteriorly.
  • Is surrounded by the axillary sheath
A

Lies in front of the prevertebral fascia

Prevertebral fascia is immediately anterior to the vertebral bodies

  • Lies anterior to the subclavian a, separated by anterior scalene muscle
  • Vertebral veins drain into the brachiocephalic veins
  • The trunks of the brachial plexus lie posteriorly
  • The axillary sheath contains axillary art and vein and brachial plexus. Axillary lymph nodes lie external to this sheath (ie not subclavian)/.
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5
Q

The branches of the subclavian artery from medial to lateral are

  • Vertebral artery/internal thoracic artery/thyrocervical trunk/costocervical trunk/dorsal scapular artery
  • Internal thoracic artery/vertebral artery/costocervical trunk/thyrocervical trunk/dorsal scapular artery
  • Vertebral artery/costocervical trunk/internal thoracic artery/thyrocervical trunk/dorsal scapular artery
  • Vertebral artery/thyrocervical trunk/internal thoracic artery/ dorsal scapular artery/ costocervical trunk
  • None of the above
A

Vertebral artery/internal thoracic artery/thyrocervical trunk/costocervical trunk/dorsal scapular artery

  • Note I have changed the answer to this question - swapped internal thoracic and thyrocervical trunk.*
  • Differing sources have different ideas, and Anatomedia states that internal thoracic is the second branch. Moores does not distinguish one specifically.*
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6
Q

Regarding the thoracic vertebrae

  • Increase in breadth from above down
  • Are heart shaped.
  • Have transverse processes of variable length, with 5th being largest
  • Are supported by the erector spinae muscle laterally
  • Have costal facets on the bodies and transverse processes.
A

Are heart shaped.

Lumbar = kidney shaped

Have costal facets on the bodies and transverse processes.

This also seems to be true

  • Increase in breadth from above down -?not mentioned in Moores
  • Have transverse processes that diminish in length from T1-T12
  • Are supported by the erector spinae muscle laterally
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7
Q

Regarding the ribs, all are true except

  • A typical rib has 2 facets.
  • The lower rib facet articulates with its own vertebrae
  • The first rib articulates with C7 and T1.
  • The last 2 ribs articulate with their own vertebrae only
  • Costochondral joints are primary cartilaginous joints.
A

The first rib articulates with C7 and T1. ​

  • A typical rib has 2 facets. The body ends in a “cup for the costal cartilage” rather than a technical facet. The head has 2 facets according to Moore’s, whilst the part of the tubercle that articulates with the transverse process is sometimes referred to as a facet in Moore’s
  • The lower rib facet articulates with its own vertebrae Articulates with T1 only
  • The last 2 ribs articulate with their own vertebrae only
  • Costochondral joints are primary cartilaginous joints. Contain hyaline cartilage  primary cart / synchondroses
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8
Q

With respect to the 1st rib

  • Anterior rami of T1 lies in contact with the neck
  • The sympathetic chain lies in contact with the shaft.
  • Subclavian artery grooves the rib.
  • Subclavian attaches to the scalene tubercle.
  • Subclavian vein does not touch the rib.
A

Subclavian artery grooves the rib.

  • Anterior rami of T1 lies in contact with the neck
  • The sympathetic chain lies in contact with the necks
    • In the superior mediastinum, the symp chain lies anterior to the necks of the ribs.
    • In the posterior mediastinum, they lie on the lateral aspects of the vertebral bodies. “Shaft” is another term for the body of a rib (Moore’s 7th ed)
  • Anterior scalene attaches to the scalene tubercle.
  • Subclavian vein touches the rib at the groove for subclavian vein
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9
Q

With respect to the 1st rib, all are true except

  • The subclavian artery lies in contact with the rib posterior to the scalene tubercle
  • The sympathetic trunk crosses anterior to the neck of the rib
  • The scalene tubercle provides insertion for the scalenus anterior muscle
  • It provides ligamentous attachment important for the sternoclavicular joint.
  • The groove for the subclavian vein lies anterior to the attachment of scalenus medius.
A

The groove for the subclavian vein lies anterior to the attachment of scalenus anterior - the scalene tubercle

  • The subclavian artery lies in contact with the rib posterior/lateral to the scalene tubercle, whereas the vein is anterior/medial
  • It provides ligamentous attachment important for the sternoclavicular joint -the Costochondral ligament, which is the major stabiliser of the joint
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10
Q

regarding the vertebral column, all are true – except

  • the facet joints in the lumbar spine lie in an anteroposterior plane.
  • the vertebral arteries ascend through the foramen in the transverse processes of the upper 6 cervical vertebrae
  • the spinous processes of the cervical vertebrae are usually bifid
  • thoracic vertebrae 1, 2 and 12 have single costal facets on pedicles
  • the sacrum has 5 sets of anterior and posterior sacral foramina, one corresponding to each of the sacral segments.
A

the sacrum has 4 sets of anterior and posterior sacral foramina

Between each of the 5 segments.

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11
Q

Which is true of the sternum

  • Jugular notch at T4
  • 2nd costal cartilage articulates separately with the manubrium and the body of the sternum
  • sternohyoid attaches to the manubrium below the 1st costal cartilage
  • interclavicular ligament makes no attachment to the sternum
  • posterior surface of the manubrium is completely covered with pleura
A

2nd costal cartilage articulates separately with the manubrium and the body of the sternum

  • Jugular notch at T2
  • sternohyoid attaches to the manubrium below the 1st costal cartilage
  • interclavicular ligament attaches to the upper part of the sternum
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12
Q

Which is not a feature of a typical rib

  • Medial facet of the tubercle faces backwards
  • Angle is the most posterior point
  • Necks are all of equal length
  • There are 3 costotransverse ligaments
  • Intraarticular ligament attaches from the horizontal ridge on the head to the intervertebral disc
A

Medial facet of the tubercle faces backwards

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13
Q

Which is true of the 1st rib

  • Scalenus medius attaches to the scalene tubercle.
  • Subclavian vein lies in the subclavian groove
  • Supreme intercostal vein lies medial to the superior intercostal artery
  • Scalenus posterior attaches lateral to the tubercle
  • Head articulates with C7 and T1.
A

Subclavian vein lies in the subclavian groove

  • Scalenus anterior attaches to the scalene tubercle.
  • Supreme intercostal vein lies medial to the superior intercostal artery
    • Not mentioned in Moores
  • Scalenus posterior attaches to the second rib
  • Head articulates with just T1
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14
Q

In the chest wall:

  • the intercostal a is more superficial than the v.
  • the intercostal a lies between the intercostal n and v
  • the transversus m lies between the ext and int intercostals
  • the NV bundle lies between the ext and int intercostals.
  • all of the above
A

the intercostal a lies between the intercostal n and v

V-A-N sup-inf

  • the intercostal a is in the same plane as the v.
  • the transversus m lies between the ext and int intercostals. Deep to both
  • the NV bundle lies between the Internal and innermost intercostals
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15
Q

Which muscle is not used in forced expiration?

  • Transversus abdominis
  • Rectus abdominis
  • Diaphragm
  • External obliques
  • Internal obliques
A

Diaphragm

Muscle of inspiration

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16
Q

Which is not a true muscle attachment of the ribs

  • Pectoralis minor – anterior surface of ribs 3-5
  • Serratus posterior superior – lateral to the angle of the 2nd – 5th ribs
  • Internal oblique – inner surface of the last 6 costal cartilages.
  • Levator costae – lateral to tubercle, on upper border
  • Rectus abdominis – anterior surface of 5-7th cartilages
A

Internal oblique – inner surface of the last 6 costal cartilages. inner surface of last 6 costal cartilages <– this is the attachment of transversus abdominus, the internal oblique is inferior border 10th – 12th ribs, external oblique from external surfaces 5th – 12th and the rectus abdominus is to the xiphoid and 5th – 7th CC. All supplied by thoracoabdominal nerves.

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17
Q

Which is true of the intercostal nerve

  • First intercostal nerve has no cutaneous supply.
  • Posterior intercostal nerve supplies the skin medial to the angle of the rib
  • Lateral cutaneous branch pierces the intercostal muscles at the anterior axillary line.
  • Anterior cutaneous branch is a cutaneous branch only
  • Anterior cutaneous branch runs behind the internal thoracic artery
A

Anterior cutaneous branch is a cutaneous branch only

  • First intercostal nerve usually has no cutaneous supply.
    • Moore’s (7e), “the first intercostal nerve has no anterior cutaneous branch and often no lateral cutaneous branch”
    • Nick marked this correct, but the answer above is definitely true, and this appears to only be true some of the time.
  • Posterior branch of the lateral cuteneous branch of the intercostal nerve supplies the skin medial to the angle of the rib
  • Lateral cutaneous branch pierces the intercostal muscles at the mid axillary line.
  • Anterior cutaneous branch runs anterior to the internal thoracic artery - the artery is in the thorax, whereas the nerve is in the wall
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18
Q

Regarding the intercostal space

  • The neurovascular bundle lies between the external and internal intercostal muscles.
  • The vein is lowermost in the NV bundle.
  • The collateral branch of the intercostal n has a cutaneous supply.
  • The 1st intercostal n has no cutaneous supply.
  • The intercostal a of the upper 3 spaces arises from the superior intercostal a.
A

The 1st intercostal n has no cutaneous supply.

First anterior rami divides into superior and inferior branches - superior -> brachial plexus, inferior -> IC nerve. First intercostal has no lateral

  • The neurovascular bundle lies between the Internal and innermost intercostal muscles.
  • The vein is most superior in the NV bundle - VAN from sup-inf
  • The collateral branch of the intercostal n does not have a cutaneous supply; only helps supply intercostal muscles and parietal pleura.
    • ​Anterior and lateral cutaneous branches provide the cutaneous supply
  • The intercostal a of the upper 2 spaces arises from the superior intercostal a (which is a branch of the costocervical trunk, off the subclavian artery)
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19
Q

Intercostal muscles

  • Are arranged in 4 neurological layers as the anterior abdominal wall.
  • Middle layer constitutes subcostals and innermost intercostals.
  • The outer layer corresponds to the internal oblique of the anterior abdominal wall.
  • Fibres of the middle layer muscles run in a downwards and forwards direction. Down and back / forward and up
  • Neurovascular plane lies between the middle and inner layer of muscles
A

Neurovascular plane lies between the middle and inner layer of muscles

  • Are arranged in 3 neurological layers as the anterior abdominal wall.
    • Assume this will be more clear during the abdominal anatomy section, but there are 3 layers of muscle.
  • Middle layer constitutes subcostals and internal intercostals.
    • External, internal, innermost.
  • The outer layer corresponds to the external oblique of the anterior abdominal wall (which makes sense - outer = external)
  • Fibres of the middle layer muscles run in a downwards and backwards (or forward and up) direction
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20
Q

Regarding the intercostal vessels and nerves

  • Lie between the external and internal intercostal muscles
  • Lie between the internal intercostals and the transversus thoracis at the front
  • Lie between the internal intercostals and the innermost intercostals at the back. Lie internal to the intercostal muscle layer at the back, and only penetrate the innermost intercostals near the angle of the rib
  • Lie between the internal intercostals and subcostals at the side
  • None of the above
A

None of the above

Lie between the internal and innermost intercostal muscles anterior to the angle of the rib - posterior to this they lie internal to the intercostal muscle layer, between the parietal pleura and muscle layer. Then they tuck in between the internal and innermost at the angle. ​

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21
Q

A typical intercostal space

  • The intercostal nerve runs between the internal intercostal and transversus thoracis muscles.
  • Vein is the lowest structure in the NV bundle
  • The artery is the most superior structure in the NV bundle
  • NV bundle runs above the rib below.
  • Collateral branch of the intercostal nerve supplies the skin overlying the space. Only supply intercostal muscles and parietal pleura
A

The intercostal nerve runs between the internal intercostal and transversus thoracis muscles.

Technically correct, runs between Internal and innermost intercostals, and transversus is deep to the innermost layer.

  • Vein is the most superior structure in the NV bundle (VAN)
  • The artery is the middle structure in the NV bundle (see above)
  • NV bundle runs below the rib above (ie on the inferior surface)
  • Collateral branch of the intercostal nerve supplies the intercostal muscles and parietal pleura - no cutaneous aspect (this is the anterior and lateral cutaneous branches)
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22
Q

regarding the chest wall

  • the intercostal artery runs between the external and internal intercostal muscles
  • the muscles of the outer thoracic wall layer are serratus posterior superior and serratus posterior inferior only.
  • the 5th posterior intercostal vein, artery and nerve run on the lower border of the 5th rib
  • the order of structures in the intercostal space are AVN.
  • the 1st intercostal nerve supplies skin over the anterior chest wall.
A

the 5th posterior intercostal vein, artery and nerve run on the lower border of the 5th rib

Named for the rib above them

  • the intercostal artery runs between the internal and innermost intercostal muscles
  • the muscles of the outer thoracic wall layer are serratus posterior superior and serratus posterior inferior only.
    • Also serratus anterior and pectoral muscles to a certain extent - not given definitively in Moores
  • the order of structures in the intercostal space are VAN
  • the 1st intercostal nerve has no cutaneous supply
    • ​T1 supplies medial forearm rather than thoracic wall
    • ​T1 supplies a small portion on the back but this is through the posterior rami, not the anterior (which the IC nerve is derived from)
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23
Q

Intercostal nerves

  • arise from the posterior rami of thoracic nerves.
  • lie inferior to the intercostal artery.
  • run between the external and internal muscle layers
  • have no cutaneous branches
  • do not connect to the sympathetic chain
A

lie inferior to the intercostal artery. ​

VAN

  • arise from the anterior rami of thoracic nerves.
  • run between the internal and innermost muscle layers
  • all except the first ICN have cutaneous branches
  • do connect to the sympathetic chain via rami communicans
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24
Q

Muscles of inspiration include all except

  • External intercostal
  • Internal intercostal
  • Diaphragm
  • Subclavius
  • Pectoralis major.
A

Internal intercostal

Moores states the

An accessory muscle of respiration, along with SCM, scalenes, serrati, and lat dorsi

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25
Q

With regard to bronchopulmonary segments which is incorrect

  • There are approx 10 segments in each lung
  • The lingula is divided into upper and lower segments.
A

The lingula is divided into upper and lower segments.

  • Answer is as per Nick, with this disclaimer:* Unclear why this is false.
  • Radiopaedia descibes it as consisting of superior and inferior segments.*
  • There are approx 10 segments in each lung (10 on right, 8-10 on left)
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26
Q

In the lung

  • The horizontal fissure is always present in the right side.
  • The fissures create a roughened surface to promote easier expansion
  • The obliquity of the fissure ensures better expansion of the apex of the lung
  • The lingula is a separate lobe of the left side.
  • Only 2% lungs have incomplete oblique fissures
A

The obliquity of the fissure ensures better expansion of the apex of the lung

  • The horizontal fissure is always (be wary of ‘always’ in medicine) present in the right side.
  • The fissures create a smooth surface to promote easier expansion.
  • The lingula is a Part of the superior lobe on the left side
  • Only 2% lungs have incomplete oblique fissures

Note that Moores does not go into much detail on fissures or their purpose.

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27
Q

The following is true of the pleura except

  • The lung apex is 2.5cm above the medial 1/3 clavicle
  • The pleura meet posteriorly in the midline.
  • Posteriorly the pleura lie 2 rib spaces below the lung
  • Anteriorly the right and left pleura diverge at the level of the 6th costal cartilage
  • Posteriorly the pleura overlie the upper poles of both kidneys
A

The pleura meet anteriorly in the midline

  • The lung apex is 2.5cm above the medial 1/3 clavicle
  • Posteriorly the pleura lie 2 rib spaces below the lung
  • Anteriorly the right and left pleura diverge at the level of the 6th costal cartilage
    • As per Moores, meet between 2-4th costal cartilages, where the left reflects away around the heart.
  • Posteriorly the pleura overlie the upper poles of both kidneys
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28
Q

Regarding the lung

  • The right pulmonary artery is longer than the left.
  • The hilum of the lung lies behind the 4th and 5th costal cartilages.
  • The bronchopulmonary nodes will drain into the hilar lymph nodes.
  • Foreign bodies are more prone to enter the left main bronchus.
  • The left lung has 3 major lobes.
A

The right pulmonary artery is longer than the left.

Presumably because the aorta arises on the left

  • The hilum of the lung lies behind the 3rd and 4th costal cartilages.
    • Answer not stated in Moore’s but as per other sources^
  • Foreign bodies are more prone to enter the right main bronchus - wider and more vertical
  • The right lung has 3 major lobes.
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29
Q

The parietal pleura

  • Projects 3 cm above the medial 1/3 of the upper surface of the clavicle
  • Projects 2 cm beyond the thoracic outlet
  • Projects 1cm above the inner border of the first rib
  • Does not project above the upper surface of the clavicle
  • None of the above
A

Projects 3 cm above the medial 1/3 of the upper surface of the clavicle

  • Projects 2-3 cm beyond the clavicle, which is superior to the thoracic outlet
  • Projects 1cm above the inner border of the first rib
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30
Q

Pleural reflections lie at which rib level in the MAL

  • 6th
  • 8th
  • 9th
  • 10th
  • 12th
A

10th

  • Pleural reflections meet the:
    • mid-clavicular line (MCL) at 8th costal cartilage
    • mid-axillary line (MAL) at the 10th rib
    • Scapula line at the 12th rib
  • ​Inferior border of the lung reaches these points 2 ribs above.
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31
Q

regarding the surface markings of the lungs, (2 CORRECT)

  • apex of lungs rises 5cm above the lateral 1/3 of the clavicle.
  • apex is 2.5cm above middle 1/3 clavicle.
  • hilum between T4 and T6.
  • oblique fissure follows approximately the 5th rib.
  • oblique fissure follows approximately the 6th rib
  • the 2 pleura diverge away at the 6th CC level behind sternum.
  • transverse (aka horizontal) fissure of the right lung is at 6th CC.
  • oblique fissure follows medial border of scapula on abducted arm
  • the lower lung border is at all points 2 ribs higher than the pleura
  • the horizontal fissure underlies the left 4th costal cartilage.
A

hilum between T4 and T6 .

Anteriorly this is 2nd to 4th costal cartilages

oblique fissure follows medial border of scapula on abducted arm

  • apex of lungs rises 2-3cm above the medial third of the clavicle
  • oblique fissure follows approximately the 5th rib.
  • oblique fissure follows approximately the 6th rib
  • the 2 pleura diverge away at the 6th CC level behind sternum. Technically true, but stated as incorrect because the left pleura diverges at the 4th CC
  • transverse (aka horizontal) fissure of the right lung is at 6th CC. 4th
  • the lower lung border is at all points 2 ribs higher than the pleura. Not close to the sternum
  • the horizontal fissure underlies the left 4th costal cartilage. Underlies the right 4th CC
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32
Q

Regarding the surface markings of the lung

  • Hilum of each lung lies behind 3rd and 4th costal cartilages at sternal margin
  • They project 2.5cm above lateral 1/3 of the clavicle.
  • The left lung curves laterally from the 4th costal cartilage
  • The lungs cross the MCL at the 8th rib
  • Oblique fissures of each lung are indicated by a line joining spine of T3 to 4th rib in the MCL
A

Hilum of each lung lies behind 3rd and 4th costal cartilages at sternal margin

  • They project 2.5cm above medial 1/3 of the clavicle.
  • The left lung curves laterally from the 4th costal cartilage, around the cardiac contour
  • The lungs cross the MCL at the 6th rib, pleura crosses at 8th
  • Oblique fissures of each lung are indicated by a line joining spine of T2 to 6th rib in MCL
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33
Q

With respect to the surface markings of the pleura

  • Left pleura arches away from the right at the 2nd CC
  • Pass the MCL at the 6th rib.
  • Cross the MAL at the 8th rib.
  • Are not reflected above the clavicle.
  • Are not reflected below the lower border of T12
A

Are not reflected below the lower border of T12

  • Left pleura arches away from the right at the 4th CC.
  • Pass the MCL at the 8th rib; Leave the sternum at 6th CC
  • Cross MCL at the 8th, MAL at the 10th
  • Extend 2-3cm above the medial third of the clavicle
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34
Q

Which of the following is not true of the surface markings of the left pleura

  • It lies behind the sternoclavicular joint
  • It lies in the midline behind the angle of Louis
  • It lies at the level of the 6th rib in the MCL
  • It crosses the MAL at level of 10th rib
  • It crosses the 12th rib at the lateral border of sacrospinalis muscle
A

It lies at the level of the 8th rib in the MCL

Behind sternum costal cartilages 2-4, reflects away from the sternum arouond the cardiac countour at 4, away from sternum at 6, MCL at 8, MAL at 10, scapular line at 12.

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35
Q

With regard to the heart

  • The right border consists of the right atrium and right ventricle.
  • The base consists of almost entirely the left atrium
  • The right border extends from the right 3rd costal cartilage to the 5th costal cartilage
  • The inferior border is mainly left ventricle.
  • The apex is found in the 5th intercostal space in the MAL.
A
  • The right border consists of the right atrium only
  • The base consists of almost entirely the left atrium
  • The right border extends from the right 3rd costal cartilage to the 5th costal cartilage.
    • Not explicit in Moores, but likely to be lower (eg 4th to 6th) as the pericardium over the roots of great vessels extends to the 3rd
  • The inferior border is mainly right ventricle (with a little bit of left)
  • The apex is found in the 5th intercostal space in the MAL. Mid-clavicular line
36
Q

Concerning the heart all are true except

  • Right border = right atrium
  • Inferior border = mostly left ventricle.
  • Apex = left ventricle
  • Anterior = right ventricle
  • Base = left atrium
A

Inferior border = mostly right ventricle

Compare to inferior surface = left ventricle

37
Q

With respect to the heart in its anatomical position

  • The right border = right atrium and right ventricle.
  • The inferior border = left ventricle.
  • Left border = mostly left atrium and small portion left ventricle.
  • Left atrium is attached behind the right atrium
  • Anterior surface = right atrium and left ventricle.
A

Left atrium is attached behind the right atrium

  • The right border = right atrium only
  • The inferior border = mostly right ventricle (and a little bit of left)
  • Left border = mostly left ventricle
  • Anterior surface = right ventricle.
38
Q

With regard to heart in its anatomical position

  • Right surface = right atrium and right ventricle
  • Anterior surface = RA, RV and a strip of LV
  • Posterior surface = LA, 4 pulmonary veins and LV
  • Inferior surface = left atrium, IVC and right ventricle
  • All of the above are true
A

Anterior surface = ‘Mainly Right ventricle’

Closest answer to correct, Moores gives the border as above

  • Right surface = mainly right atrium
  • Posterior surface = does not exist
    • ​Surfaces are anterior, inferior, left, and right
  • Inferior surface = left ventricle
39
Q

Which heart valve has 2 cusps

  • Aortic
  • Mitral
  • Pulmonary
  • Pulmonary and aortic
  • Tricuspid
A

Mitral

All others

40
Q

With regard to the coronaries: (2 CORRECT)

  • right arises from the posterior coronary sinus.
  • left supplies the conducting system in most patients
  • right supplies the PDA in most patients
  • there are no arterial anastomoses between right and left.
  • the right marginal vein drains directly into the coronary sinus.
  • the anterior cardiac veins drain into the coronary sinus.
  • venae cordis minimae occur most frequently in the atrium
  • Cx is most commonly affected by disease.
A

left supplies the conducting system in most patients

Right supplies SAN and AVN, but left supplies most of the bundle of His

venae cordis minimae occur most frequently in the right atrium

Moores notes mainly the atria, does not specify a side

  • right arises from the right coronary sinus.
  • right supplies the PDA in most patients
  • in about 10% of normal hearts there are anastamoses between the L + R coronaries in the coronary sinus, and the ant + post IV arteries around the apex of the heart
  • the right marginal vein Drains into the small cardiac vein, not directly into the coronary sinus (Left marginal drains directly)
    • Appears only small, middle, and great veins, and left posterioor ventricular and left marginal veins drain into the sinus
  • the anterior cardiac veins drain into the right atrium
  • Sites of occlusions: LAD 50%, RCA 30%, L circumflex 20%
41
Q
  1. The major arterial supply to the interventricular septum originates from the
  • a. Circumflex artery
  • b. Marginal artery
  • c. Posterior descending (post interventricular)
  • d. Anterior descending (ant interventricular)
  • e. Conus artery
A

d. Anterior descending

<– 2/3 from the (L)CA via the anterior IV/LAD

42
Q

Regarding the RCA

  • Course through the L auricle and infundibulum.
  • Supplies 60% AV node.
  • Usually has a posterior interventricular branch.
  • Supplies 30% SA node.
A

Usually has a posterior interventricular branch.

2/3 of the time, other 1/3 by the left coronary

  • Runs in the coronary sulcus between the RA and pul trunk
  • Supplies AVN 80% of the time
  • Supplies SAN 60% of the time (left circumflex 40% of the time)
43
Q

Left dominance means

  • Left side of the heart is more important.
  • Posterior interventricular branch is given off from the RCA.
  • Posterior interventricular branch is given off by a large anterior interventricular artery off the LCA
  • Is more common than right dominance
  • It is given off directly from the LCA
A

Posterior interventricular branch is given off by a large anterior interventricular artery off the LCA

  • ie the anterior IV artery (LAD) wraps around the apex to give the posterior IV artery*
  • Dominance is determined by which artery gives off the posterior IV artery*
44
Q

The LCA

  • Arises in front of the pulmonary trunk.
  • Emerges between the left auricle and the infundibulum of the right ventricle
  • Usually supplies the AV node.
  • Supplies SA node in 60% people
  • Runs in the atrioventricular groove
A

Emerges between the left auricle and the infundibulum of the right ventricle

  • Arises Behind the pul trunk
  • Supplies the AV node only 20% of the time
  • Supplies SA node in 40% people.
  • Runs in the atrioventricular groove
45
Q

Which of the following is not usually a branch of the RCA

  • Marginal
  • AV nodal
  • Conus
  • Posterior interventricular
  • Circumflex
A

Circumflex

RCA -> branch to SAN, right marginal branch, branch to AVN, posterior IV branch

LCA -> ant IV branch (->lateral branch) + circumflex (-> left marginal branch)

46
Q

The LCA (2 correct)

  • Arises from the left anterior aortic sinus.
  • Usually supplies the AV node.
  • May supply the right auricular appendage
  • Passes forwards around the atrioventricular groove.
  • Usually supplies the SA node.
  • Dominant in 60%.
  • Continues as the anterior interventricular artery.
  • Gives rise to the anterior interventricular artery.
  • In 40% gives rise to SA nodal a
A

In 40% gives rise to SA nodal a

May supply the right auricular appendage

Apparently

Gives rise to the anterior interventricular artery.

Not given as correct, but definitely is (LCA -> AIV + Cx)

  • Arises from the left aortic sinus (just left, not left anterior)
  • Supplies the AV node in 20% of people
  • Passes forwards around the atrioventricular groove.
  • Supplies SA node in 40%
  • Dominant in 33% (dominance is whichever gives off the posterior IV artery - 2/3rds right).
  • Gives off the anterior interventricular artery as it branches into AIV and Cx (but does not continue)
47
Q

Trachea:

  • commences below the cricoid at level of C5.
  • enters the thoracic inlet slightly to the left
  • is marked at its lower end by the level of the sternal angle
  • supplied by IX
  • drains to axillary lymph nodes.
A

is marked at its lower end by the level of the sternal angle

  • commences below the cricoid at level of C6
  • enters the thoracic inlet slightly to the right of the midline.
    • Oesophagus enters a little to the left
  • supplied by X
  • drains to axillary lymph nodes. Tracheal / paratracheal nodes -> bronchomediastinal nodes (sup/inf) -> trunks -> Venous angles
48
Q

Which vessel passes directly behind the right hilum

  • Right phrenic nerve
  • Right X
  • Azygous vein
  • Internal thoracic artery
  • Hemi-azygous vein
A

Right X

Azygous vein

Nick gives the answer as Azygos vein. Both pass posterior to the root of the lung, the azygos arches over the top of it. Some pictures make it appear the vagus is more anterior/closer to the root however. Moores does not seem to specify.

  • Right phrenic nerve - run anterior to the hila (cf vagus which run posterior)
  • Internal thoracic artery - branch of subclavian, pretty sure this runs anteriorly
  • Hemi-azygous vein - is on the left
49
Q
  1. In the superior mediastinum
  • a. The apex of the left lung abuts the trachea
  • b. The left vagus is in contact with the trachea
  • c. The right phrenic descends in contact with SVC
  • d. The azygos vein hooks under the right main bronchus
  • e. SVC runs posterior to the right main bronchus - anterior
A

c. The right phrenic descends in contact with SVC​

  • Apparently. All others appear wrong. Definitely descends to diaphragm in contact with IVC.*
  • ‘Passes along the right side of right brachiocephalic vein, SVC, and the pericardium over the right atrium’*
  • a. The apex of the left lung abuts the trachea - Not specficially mentioned but does not seem right
  • b. The left recurrent laryngeal nerve is in contact with the trachea
    • vagus descends between left common carotid and subclavian arteries, anterior to the arch of aorta then posoterior to the root of left lung. The RLN passes under the arch aorta posteriorly, then ascends between trachea and oesophagus
  • d. The azygos vein hooks over the right main bronchus
  • e. SVC runs anterior to the right main bronchus
50
Q
  1. The vagus nerve
  • a. Arises in a series of rootlets from the pons
  • b. Lies outside the carotid sheath in the neck
  • c. Supplies muscles of the larynx via the recurrent laryngeal nerve
  • d. Passes in front of the root of the lung
  • e. Has a superior and inferior ganglion within the jugular fossa
A

c. Supplies muscles of the larynx via the recurrent laryngeal nerve – except cricothyroid via the external branch of the superior laryngeal nerve

  • a. Arises from the medulla
  • b. Lies within the carotid sheath in the neck
    • As do the common + internal carotids, IJVs, and lymph nodes; upper part contains XI, XI, XII
  • d. Passes posterior to the root of the lung (in contrast to the phrenic nerves)
  • e. Has a superior and inferior ganglion within the jugular fossa
51
Q

What lies posterior to the right root of the lung

  • Aorta
  • R phrenic n.
  • R X
A

R X

Have also seen this question with the azygos vein as the answer

  • Aorta - Posterior to the root of the left lung
  • R phrenic n - Anterior
52
Q

The right phrenic n

  • Passes down through the mediastinum posterior to the lung root.
  • Is the sole motor supply to the right dome of diaphragm and crus
  • Gives off the right recurrent laryngeal nerve in the neck
  • Contains 50% motor and 50% sensory fibres.
  • Divides into 2 main branches on the under surface of the diaphragm.
A

Is the sole motor supply to the right dome of diaphragm and crus

  • Passes down through the mediastinum anterior to the lung root.
  • The vagus gives off the right recurrent laryngeal nerve in the neck.
  • Contains 33% sensory fibres.
    • Notably includes sensation from the pericardium, hence pain in this region may be referred to the supraclavicular region
  • Divides on the under surface of the diaphragm, however Moores makes no mention of the number of branches. Presumably more of a plexus.
53
Q

the anterior mediastinum contains

  • the heart.
  • the phrenic n.
  • azygous v.
  • thymus
  • all of the above
A

thymus

  • the heart - Middle
  • the phrenic n - Middle (and superior)
  • azygous v - Post (and presumably a bit of middle when it crosses the right hilum and enters the SVC)
54
Q

The phrenic n

  • Arises principally from C5.
  • On the right side enters the abdomen with IVC
  • Has no sensory fibres.
  • Lies posterior to the anterior scalene muscle.
  • None of the above are true
A

On the right side enters the abdomen with IVC

Given as correct, Moores states it pierces the diaphragm ‘near the caval opening’

  • Arises principally from C4
  • Has sensory fibres to pericardium and mediastinal pleura
  • Lies posterior to the anterior scalene muscle. Anterior to anterior scalene
55
Q

All are true except:

  • The arch of the aorta lies wholly in the superior mediastinum
  • The right X is in contact with the trachea and apex of the lung
  • In the neck the internal jugular vein is medial to the common carotid.
  • There are no valves in the SVC, brachiocephalic or azygous veins
  • The trachea commences at C6 and bifurcates at T5
A

In the neck the internal jugular vein is lateral to the common carotid.

56
Q

The phrenic n supplies all except.

  • Sensory to the diaphragm
  • Motor to the diaphragm
  • Sensory to the mediastinal pleura
  • Sensory to the parietal serous pericardium
  • Sensory to the fibrous pericardium
A

Sensory to the parietal serous pericardium

Fibres run on the outside of the fibrous pericardium, and supply it with sensation (as per Wikipedia, and makes anatomical sense; otherwise they would pierce the fibrous layer without supplying it)

Moore’s just states, “sensory fibres to pericardium and mediastinal pleura”.

57
Q

The trachea

  • In the upper mediastinum runs posterior to the oesophagus.
  • Has pleura attached to the right side by not the left
  • The pulmonary trunk divides to the left of the carina
  • Gaps in the cartilaginous rings lie anteriorly.
  • Isthmus of the thyroid is attached to the 6th tracheal ring.
A

The pulmonary trunk divides to the left of the carina

Nick gives below as the answer, but Radiopaedia reckons the above is true (and looking at pictures it appears so). I havent come across anything stating the below.

Has pleura attached to the right side by not the left

  • In the upper mediastinum runs anterior to the oesophagus.
  • Gaps in the cartilaginous rings lie Posteriorly
  • Isthmus of the thyroid is Anterior to 2nd and 3rd rings
58
Q

The oesophagus

  • Cervical portion lies behind the prevertebral fascia.
  • Is crossed anteriorly by right pulmonary artery
  • Is indented by the right main bronchus.
  • The middle portion is supplied by oesophageal branches of the left gastric artery.
  • Nerve supply to the upper third is supplied by the oesophageal plexus.
A

Is crossed anteriorly by right pulmonary artery

Pulmonary trunk divides to the left, and the right crosses across the oesophagus as it heads to the right lung

  • Cervical portion lies anterior to the prevertebral fascia.
  • Is indented by the left main bronchus
    • other 2 points of constriction are arch of aorta, and diaphragm
  • The middle portion is supplied by oesophageal branches of the aorta (usually 2, up to 5)
  • Upper third is striated muscle supplied by the vagus nerve (without any plexus intermediates)
59
Q

The azygos vein

  • usually enters the right subclavian vein
  • only drains the middle 1/3 of the oesophagus
  • only drains part of the oesophagus and bronchial vein
  • passes forward anteriorly medial to oesophagus from T3.
  • arches over the right bronchus at the level of T4
A

arches over the right bronchus at the level of T4

  • usually enters the SVC
  • only drains the middle 1/3 of the oesophagus
    • Not specified in Moores
  • Drains posterior intercostals, back, vertebra and vertebral canal, mediastinal, oesophagial and bronchial veins.
  • passes forward anteriorly medial to oesophagus from T4
60
Q

The brachiocephalic veins

  • Are formed from the confluence of external jugular and subclavian veins.
  • Are formed from behind the body of the sternum.
  • the left only receives the superior intercostal vein.
  • On the right receives the thoracic duct.
  • Receives tributaries corresponding to branches of the second part of the subclavian a
A

the left only receives the superior intercostal vein.

Right superior intercostal drains into the azygous

  • Are formed from the confluence of internal jugular and subclavian veins.
  • Are formed behind the sternoclavicular joints
  • On the left receives the thoracic duct.
  • Receives tributaries corresponding to branches of the second part of the subclavian a
    • Costocervical trunk -> superior intercostal and deep cervical artery
    • Deep cervical vein -> vertebral vein, not brachiocephalic
61
Q

The phrenic nerves

  • Are derived from C4,5 and 6.
  • Provide motor supply only to the diaphragm
  • Pass posterior to the lung roots
  • Pierces the muscle of the diaphragm on the left side.
  • Traverses the diaphragm at T10 level on the right
A

Provide motor supply only to the diaphragm

I cannot find anything to dispute the above. Below is as per Nick. Both appear to be correct.

Pierces the muscle of the diaphragm on the left side.

  • On the right, passes through the caval opening (T8)*
  • (Note Moores states the the right phrenic ‘pierces [the diaphragm] near the caval opening’; does not state it passes through it. The left ‘pierces the diaphragm to the left of the pericardium’)*
  • Are derived from C3-5
  • Pass anterior to the lung roots (vagus is posterior)
  • Traverses the diaphragm at ?t12 level on the right (not mentioned in Moores)
62
Q

In the thorax

  • The carina lies at the level of the upper border of T4 in a cadaver.
  • The thoracic duct drains into the SVC.
  • C4 and T3 are adjacent dermatomes
  • The trachea lies in contact with the manubrium
  • The apex of the lung is above the thoracic inlet.
A

The trachea lies in contact with the manubrium

  • The carina lies at the level of the T4/T5 disc in a cadaver.
  • The thoracic duct drains into the Left brachiocephalic vein
  • C4 and T2 are adjacent dermatomes (as per Moores)
  • The apex of the lung is level with the thoracic inlet.
    • Nick unsure why this was wrong - apex is 2-3cm above the medial aspect of clavicle, but only to the top of the first rib, which is higher. This is the level of the thoracic inlet.
63
Q

All of the following are true regarding the phrenic nerve except

  • It is formed principally by C4
  • It runs down the anterior surface of scalenus anterior
  • It is the sole motor supply to the diaphragm
  • It runs posterior to the lung root
  • On the under surface of the diaphragm each split into 3 main branches
A

It runs anterior to the lung root

64
Q

With respect to the contents of the posterior mediastinum, all are true except

  • The oesophagus extends from the level of the cricoid cartilage to traverse the diaphragm at T10
  • The descending thoracic aorta gives off the posterior intercostal artery
  • It contains the perihilar LN
  • The oesophagus is 25cm length
  • The descending aorta commences at the lower level of T4
A

It contains the perihilar LN

Presumably middle mediastinum

65
Q

Which structure does not lie in the plane of lower border T4

  • Convexity of the arch of the aorta
  • Junction between superior and inferior mediastinum
  • Sternomanubrial joint
  • Azygous enters SVC
  • Bifurcation of the trachea
A

Convexity of the arch of the aorta

Arch begins and ends at T4, the convexity will be above this

66
Q

Which relation of the arch of the aorta is incorrect

  • Left recurrent laryngeal nerve is on its right
  • Pulmonary trunk bifurcation in its concavity
  • Ligamentum arteriosum from its concavity, distal to the origin of the left subclavian artery
  • Left supreme intercostal vein on its left
  • Oesophagus on its right
A

Left supreme intercostal vein on its left

67
Q

Which is not true of the oesophagus

  • There is usually a constriction at 27 cm from lips where the left main bronchus crosses
  • Crosses in front of the descending aorta
  • Upper part drains into the azygous vein
  • Begins at the level of C6
  • Receives nerve supply from the recurrent laryngeal nerve
A

Upper part drains into the ??? vein

68
Q

Phrenic nerve supplies the sensation to all but

  • Diaphragm
  • Mediastinal pleura
  • Peritoneum
  • Left ventricle
  • Pericardium
A
69
Q

Which is true of X

  • Left X is held away from the trachea by branches of the aortic arch
  • Run in front of lung roots.
  • X trunks receive fibres from the ipsilateral nerve only.
  • Left X crosses the aortic arch superficial to the left superior intercostal vein
  • Right X runs superficial to the azygous vein
A

Left X is held away from the trachea by branches of the aortic arch

Left common carotid and subclavian arteries

  • Run behind lung roots
  • X a**nterior and posterior trunks each receive fibres from L and R vagus nerves
  • Left X crosses the aortic arch deep to the left superior intercostal vein
  • Right X runs deep to the azygous vein - As it crosses anteriorly over the hilum to join the SVC, the X runs between it and the trachea
70
Q

Which is true of the thoracic sympathetic trunk

  • Passes into the abdomen behind the lateral arcuate ligament
  • Greater splanchnic nerve comes off 3-7th thoracic ganglia.
  • 1st thoracic ganglion often fuses with the inferior cervical ganglion
  • crosses 1st rib lateral to the superior intercostal artery
  • gives fibres to the oesophageal plexus
A

1st thoracic ganglion often fuses with the inferior cervical ganglion

Greater splanchnic nerve comes off 5-9th thoracic ganglia

71
Q

Regarding the descending part of the thoracic aorta

  • Component of middle mediastinum.
  • Begins at level of T3.
  • Passes through the diaphragm behind the lateral arcuate ligament.
  • Begins at the beginning of the arch of the aorta.
  • Passes to the abdomen at the level of T12
A

Passes to the abdomen at the level of T12

Oesophagus at T10

  • Component of posterior mediastinum.
  • Begins at level of T4/5 (thoracic plane)
  • Passes behind the diaphragm
  • Begins at the end of the arch of the aorta
72
Q

The arch of the aorta

  • Reaches the level of the sternal notch.
  • Contains baroreceptors in the region of the ligamentum arteriosum
  • Gives rise to the brachiocephalic trunk on the left.
  • Is crossed on the left side by the phrenic and vagus n
  • Gives off 4 major branches.
A

Is crossed on the left side by the phrenic and vagus n

Vagus crosses anteriorly, gives off the left phrenic which passes under and posterioly the arch to ascend in between oesophagus and trachea

  • Does not reache the level of the sternal notch - Arch is at T4, sternal notch is T2
  • Contains baroreceptors in between the BC trunk and left CC
    • ligamentum arteriosum is just distal to the left subclavian
  • Gives rise to the brachiocephalic trunk on the Right
  • Gives off 3 major branches - brachiocephalic trunk, left common carotid, left subclavian
73
Q

The arch of the aorta

  • Curves laterally over the left bronchus.
  • Reaches as high as the sternal angle.
  • Contains chemoreceptors in its adventitial layer.
  • Gives off the right common carotid artery.
  • Is crossed on its left side by the phrenic n
A

Is crossed on its left side by the phrenic n ​

  • Phrenic enters mediastinum between subclavian artery and origin of brachiocephalic veins, pass anterior to the hilar of the lungs (thus must be on left side of the arch)*
  • Vagus descends anteriorly to arch (/its left side), recurrent laryngeal wraps under to its right side*
  • Curves laterally over the left bronchus.
    • As per Moores: ‘arches superiorly, posteriorly and to the left, and then inferiorly’
    • Nick questioned how this was not correct - presumeably because it is more posterolateral than lateral.
  • Begins at the sternal angle - thus it must ascend higher than this
  • Aortic bodies are located between the arch of aorta and pulmonary trunk. Cannot find exactly where but seem to be outside th aorta itself
  • Gives off the left common carotid artery, on the right is the Brachiocephalic trunk
74
Q

The arch of the aorta

  • The ligamentum arteriosum attaches just below the origin of the right subclavian artery.
  • Is crossed on its left side by the phrenic n
  • The trachea lies on the left side of the arch.
  • Passes backward over the right bronchus.
  • Is crossed on its right side by X.
A

Is crossed on its left side by the phrenic n

  • The ligamentum arteriosum attaches just below the origin of the left subclavian artery.
  • The trachea lies on the right side of the arch.
  • Passes backward over the left bronchus.
  • Is crossed on its left side by X.
    • Right X descends on the trachea, then passes posterior to the SVC, brachiocephalic vein, and right hilum.
75
Q

the arch of the aorta

  • contains baroreceptors in its intima
  • extends from the manubriosternal joint to the body of T4
  • gives rise to 4 major arteries.
  • is crossed on its right by the X and phrenic n
  • lies anterior to the oesophagus and the trachea
A

lies anterior to the oesophagus and the trachea

Ascending is anterior, arch is antero-lateral-superior, descending is more lateral

  • contains baroreceptors in its Adventitia
  • gives rise to 3 major arteries.
  • is crossed on its left by the X and phrenic n
  • extends from the manubriosternal joint to the body of T4
    • Arch starts and ends at the level of transthoracic plane - at T4/5 level to manubriosternal joint (2nd CC)
    • Could potentially be correct, but the answer above seems ‘more’ correct
76
Q

The oesophageal opening in the diaphragm is opposite:

  • T6
  • T8.
  • T10.
  • T11
  • T12.
A

T10

  • T8 = IVC*
  • T12 = aorta*
77
Q

the diaphragm:

  • has the oesophageal opening opposite the T8 vertebrae.
  • is supplied by C4, C5, C6.
  • has a major role in expiration
  • has a vena cava opening at T10.
  • has an aortic opening opposite T12
A

has an aortic opening opposite T12

  • has the oesophageal opening opposite the T10 vertebrae.
  • is supplied by C3-5
  • has a major role in inspiration (expiration is usually passive, when active it does not involve the diaphragm)
  • has a vena cava opening at T8
78
Q

The oesophageal opening in the diaphragm

  • Is at T8
  • Transmits the X
  • Transmits the thoracic duct
  • Transmits branches of the right gastric artery
  • Transmits the right phrenic nerve
A

Transmits the X

  • Is at T10 (T8 = IVC)
  • Aortic hiatus transmits the thoracic duct (and azygos vein)
  • Transmits branches of the right gastric artery (???)
  • Caval opening transmits the right phrenic nerve (left pierces the muscle)
    • ​If anything - Moores states the right phrenic pierces the diaphragm ‘near the caval opening’
79
Q

With respect to the diaphragm

  • The oesophageal opening is opposite T8 behind the 7th CC
  • It is supplied by C5, C6 and C7
  • Its major function is forced expiration
  • Its blood supply is only from the aorta
  • The aortic opening is opposite T12 between the overlapping right and left crural fibres
A

The aortic opening is opposite T12 between the overlapping right and left crural fibres

  • The oesophageal opening is opposite T10
  • It is supplied by C3-5
  • Its major function is forced inspiration
  • Its blood supply is from the aorta, and terminal branches of internal thoracic artery (musculophrenic and pericardiophrenic)
80
Q

Which passes through the diaphragm with the oesophagus

  • Azygous vein
  • Right X
  • Sympathetic trunks
  • Thoracic duct
  • Phrenic nerve
A

Right X

  • Azygous vein - aortic hiatus
  • Sympathetic trunks - pass behind the diaphragm
  • Thoracic duct - aortic hiatus
  • Phrenic nerve - either piece the muscle (left) or caval opening (maybe right - maybe it also pierces)
81
Q
  1. The diaphragm
  • a. Has an aortic opening which transmits the right vagus nerve
  • b. Has an oesophageal opening at the level of T8
  • c. Is pierced by the left phrenic nerve at the left dome
  • d. Is supplied in its central part mainly by the pericardiophrenic and musculophrenic arteries
  • e. Has a left dome which lies higher than the right dome
A

c. Is pierced by the left phrenic nerve at the left dome

(not listed clearly in Moore’s)

  • a. Has an oesophageal (T10) opening which transmits the right vagus nerve
  • b. Has an oesophageal opening at the level of T10
  • d. Is supplied in its central part partly by the pericardiophrenic and musculophrenic arteries
    • The superior phrenic (from the thoracic aorta) anastamoses with these to supply the superior surface; the inferior phrenic the inferior surface
  • e. Has a right dome which lies higher than the left dome
82
Q

The oesophageal opening in the diaphragm transmits all except

  • X trunk
  • Oesophageal branches of the gastric a
  • Lymphatics
  • R phrenic n.
  • Veins (oesophageal branches of gastric v)
A

R phrenic n.

Passes through caval opening at T8

83
Q

The vena cava foramen in the diaphragm is at level of

  • T12
  • T8
  • T10
  • L1
  • C7
A

T8

  • AOC 12,10,8*
  • (Aorta, oesophagus, Caval)*
84
Q

Regarding the diaphragm which is incorrect

  • Aorta – T12
  • Oesophagus - T10
  • Vena cava – T8
  • X trunk - T12
  • Phrenic n – T8.
A

X trunk - T10

  • Passes through oesophageal hiatus*
  • Right phrenic through caval opening (or near it), left at a similar level*
85
Q

The diaphragm

  • In full expiration may rise up to the 6th rib anteriorly
  • The aortic opening is in the central tendon.
  • The thoracic duct is transmitted through the vena caval foramen.
  • The oesophageal opening is opposite T8.
  • Left crus arises from the upper 2 lumbar vertebrae
A

Left crus arises from the upper 2 lumbar vertebrae

Right from upper 3 lumbar vertebra

  • In full expiration may rise up to the ??? rib anteriorly
  • The caval opening is in the central tendon
  • The thoracic duct is transmitted through the Aortic opening
  • The oesophageal opening is opposite T10
86
Q

Attachments to the diaphragm include all but

  • Left crus
  • Tip of 12th rib.
  • Xiphisternum
  • Median arcuate ligament
  • 7th costal cartilage
A

Median arcuate ligament

MED_IAL_ arcuate ligament is an attachment, Median surrounds the aortic hiatus

Diaphragm attachments:

  • Sternal part: 2 muscular slips to posterior aspect of the xiphisternum
  • Costal part: Internal surfaces of 7th -12th (inferior 6) costal cartilages
  • Lumbar part: Arises from medial and lateral arcuate ligaments, and the (L) and (R) crura centrally
87
Q

Which is true of the NV supply of the diaphragm

  • Inferior phrenic arteries are the sole supply of the diaphragm
  • Phrenic nerves are motor only
  • All of fibres of the right crus are supplied by the right phrenic nerve
  • Phrenic nerve divides into anterior, posterior and lateral branches on the thoracic surface
  • Lower intercostal nerves supplying proprioception only.
A

All of fibres of the right crus are supplied by the right phrenic nerve

Phrenic nerves are the sole motor supply to the diaphragm, unlikely they would cross sides.

Lower intercostal nerves supplying proprioception only. ??????

Nick gives this as the answer, with the caveat of ‘?????’

  • Inferior phrenic arteries are not the sole supply of the diaphragm
    • Superior phrenic, musculophrenic, and pericardiophrenic on the superior surface
  • Phrenic nerves are motor only to the diaphragm, but also supply sensation to the diaphragm, pericardium etc
  • Phrenic nerve divides into branches, but Moores does not seem to identify a number or named ones.

Anatomy (6 decks)

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